Second Wave Of Coronavirus Disease 2019 Research Articles

Evaluation of Burnout among Medical Officers and Dental Surgeons in State Health Services using Maslach's Burnout Inventory during COVID-19: A Cross Sectional Study.

The Coronavirus disease 2019 (COVID-19) pandemic became a worldwide public health crisis. It leads to raised levels of burnout and anxiety among the people of the medical and dental fraternity, especially those involved in various duties related to COVID-19. The present research focused on evaluating the prevalence and predictors of burnout among medical officers and dental surgeons in Haryana's state dental health services. A cross-sectional study was conducted to assess burnout among medical officers and dental surgeons involved in COVID-19-related duties in state health services. Maslach's burnout scale was used to evaluate burnout. It is a prevalidated and self-administered questionnaire with three domains, that is, emotional exhaustion (EE), personal accomplishment (PA) assessment, and depersonalization (DP). The Chi square test, Student's t test (unpaired), and analysis of variance (ANOVA) with post hoc analysis were done wherever applicable. Pearson's correlation analysis was used to check the relationship among EE, DP, and PA. A total of 200 study participants responded to the online survey. Nearly half of them (51%) were aged 25-34 years. The majority had service experience of up to 20 years (90%). Almost three-fourths (72%) of study participants performed duties for >8 h a day. Up to 86% reported that the second wave of COVID-19 caused increased burnout. Moderate-to-high degrees of occupational exhaustion (OE) and DP were reported among approximately 42% of study participants. Medical officers were reported to have statistically significantly higher levels of burnout compared to dental surgeons (P < 0.05). Moderate levels of burnout were reported among half of the study participants, suggestive of the need to address the issues related to mental health of healthcare providers.

Metagenomic insights into fungal community composition of the nasopharyngeal region of COVID-19 associated mucormycosis patients from India.

Coronavirus disease 2019 (COVID-19) associated mucormycosis (CAM) was reported predominantly from India during the second wave of COVID-19 and has a high mortality rate. The present study aims to understand the fungal community composition of the nasopharyngeal region of CAM-infected individuals and compare it with severe COVID-19 patients and healthy controls. The fungal community composition was decoded by analyzing the sequence homology of theinternal transcribed spacer-2-(ITS-2)region of metagenomic DNA extracted from the upper respiratory samples. The alpha-diversity indices were found to be significantly altered in CAM patients (p < 0.05). Interestingly, a higher abundance of Candida africana, Candida haemuloni, Starmerella floris, and Starmerella lactiscondensi was observed exclusively in CAM patients. The interindividual changes in mycobiome composition were well supported by beta-diversity analysis (p < 0.05). The current study provides insights into the dysbiosis of the nasal mycobiome during CAM infection. In conclusion, our study shows that severe COVID-19 and CAM are associated with alteration in mycobiomeas compared to healthy controls. However, the sequential alteration in the fungal flora which ultimately leads to the development of CAM needs to be addressed by future studies.

Acute intracranial hemorrhage in 76 COVID-19 patients during the first and second pandemic waves

Background/Aim. There is limited data on the frequency of intracranial hemorrhage (ICrH) in the first wave [beta variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)] and second wave (delta variant of SARS-CoV-2) coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to analyze the appearance of ICrH in COVID-19 patients (CP). Methods. Among 505 CP treated at the Special Hospital for Cerebrovascular Diseases ?Sveti Sava? intermittently during the 2020-2021 period, ICrH was diagnosed in 76 (15.1%) patients. The available information from the medical records regarding clinical, demographic, as well as radiological data (multislice computed tomography examination of the endocranium) was collected and analyzed. Results. In the first wave, out of 308 CP, 63 (20.5%) were diagnosed with ICrH. In the second wave, out of 197 CP, ICrH was diagnosed in 13 (6.6%) patients, which was a statistically significant difference (p &lt; 0.002). There was no statistically significant difference for the presence of hyper-tension (p = 0.271), diabetes mellitus (p = 0.558), and chronic obstructive pulmonary disease (p = 0.794) among CP with ICrH comparing the two waves of the pandemic. However, a statistically significant difference was proven in the frequency of patients with atrial fibrillation and anticoagulant drug therapy (p = 0.021 each). There was no statistically significant difference in the frequency of patients with fever (p = 0.637), fatigue (p = 0.587), hemiparesis (p = 0.831), respiratory symptoms (p = 0.289), and loss of consciousness (p = 0.247). D-dimer values in the second pandemic wave were statistically significantly lower (p = 0.003). The combina-tion of ischemic stroke and ICrH was six times more common in the second wave (p = 0.003). However, cer-ebral parenchymal hemorrhage was two times less frequent (p = 0.001) in the second wave but with statisti-cally higher frequencies of multifocal (23.1%) and dif-fuse type (36.4%) of ICrH (p = 0.007). Combined hem-orrhages, as well as subarachnoid and subdural subtypes, were more common in the second wave (23.1% each). Fatal outcomes occurred in 38.1% of patients in the first wave compared to 69.2% in the second wave (p = 0.039). Conclusion. In the first pandemic wave of COVID-19, ICrH in CP was significantly more frequent and D-dimer was singled out in laboratory analyses, the values of which were statistically significantly higher in comparison with second wave. In the second wave of COVID-19, parenchymal ICrH was less frequent and multifocal and diffuse ICrH were more common in CP with ICrH. The mortality rate was very high in the sec-ond wave.

Determinants for university students’ location data sharing with public institutions during COVID-19: The Italian case

Abstract Data on real-time individuals’ location may provide significant opportunities for managing emergency situations. For example, in the case of outbreaks, besides informing on the proximity of people, hence supporting contact tracing activities, location data can be used to understand spatial heterogeneity in virus transmission. However, individuals’ low consent to share their data, proved by the low penetration rate of contact tracing apps in several countries during the coronavirus disease-2019 (COVID-19) pandemic, re-opened the scientific and practitioners’ discussion on factors and conditions triggering citizens to share their positioning data. Following the Antecedents → Privacy Concerns → Outcomes (APCO) model, and based on Privacy Calculus and Reasoned Action Theories, the study investigates factors that cause university students to share their location data with public institutions during outbreaks. To this end, an explanatory survey was conducted in Italy during the second wave of COVID-19, collecting 245 questionnaire responses. Structural equations modeling was used to contemporary investigate the role of trust, perceived benefit, and perceived risk as determinants of the intention to share location data during outbreaks. Results show that respondents’ trust in public institutions, the perceived benefits, and the perceived risk are significant predictor of the intention to disclose personal tracking data with public institutions. Results indicate that the latter two factors impact university students’ willingness to share data more than trust, prompting public institutions to rethink how they launch and manage the adoption process for these technological applications.

Korean adolescents' coping strategies on self-harm, ADHD, insomnia during COVID-19: text mining of social media big data.

Since the Coronavirus disease 2019 (COVID-19), public safety measures, including social distancing and school closures, have been implemented, precipitating psychological difficulties and heightened online activities for adolescents. However, studies examining the impact of the pandemic on adolescent mental health and their coping strategies in Asian countries are limited. Further, most studies have used survey measures to capture mental health challenges so far. Accordingly, this study aimed to examine the psychological challenges South Korean adolescents experienced and their coping strategies during the pandemic using the Natural Language Processing (NLP) and Text mining (TM) technique on adolescents' social media texts/posts. The data were gathered from social media texts/posts such as online communities, Twitter, and personal blogs from January 1, 2019, to October 31, 2021. The 12,520,250 texts containing keywords related to adolescents' common psychological difficulties reported during the pandemic, including self-harm, Attention-Deficit/Hyperactivity Disorders (ADHD), and insomnia, were analyzed by TM, NLP using information extraction, co-occurrence and sentiment analysis. The monthly frequency of the keywords and their associated words was also analyzed to understand the time trend. Adolescents used the word "self-harm" in their social media texts more frequently during the second wave of COVID-19 (August to September 2020). "Friends" was the most associated word with "self-harm." While the frequency of texts with "Insomnia" stayed constant throughout the pandemic, the word "ADHD" was increasingly mentioned in social media. ADHD and insomnia were most frequently associated with ADHD medications and sleeping pills, respectively. Friends were generally associated with positive words, while parents were associated with negative words. During COVID-19, Korean adolescents often expressed their psychological challenges on social media platforms. However, their coping strategies seemed less efficient to help with their difficulties, warranting strategies to support them in the prolonged pandemic era. For example, Korean adolescents shared psychological challenges such as self-harm with friends rather than their parents. They considered using medicine (e.g., sleeping pills and ADHD medication) as coping strategies for sleep and attention problems.

Prehospital Time Intervals in Thailand during COVID-19

Objective: To determine the effect of the coronavirus disease, 2019 (COVID-19) pandemic on the prehospital time intervals of emergency medical services (EMS) in Thailand. Material and Methods: This retrospective cohort study analyzed the prehospital time intervals of EMS in Thailand; from January 1, 2019 to September 30, 2021 using data obtained from the national EMS database. Patients with incomplete medical records, prehospital time intervals &lt;1 or &gt;300 minutes, and those admitted between January 1 and March 31, 2020 were excluded. Data were compared between the following groups: Group 1, pre-COVID-19; Group 2, first- and second-wave of COVID-19; and Group 3, third-wave of COVID-19: Kruskal–Wallis, Wilcoxon rank-sum, and chi-square tests were used. Results: A total of 3,863,153 patients were enrolled into this study. The median total prehospital time was significantly longer in Group 2 when compared to Group 1, [25 (17,34) vs. 24 (17,33) minutes, p-value&lt;0.001]; longer on-scene time, [4 (2,7) vs. 3 (2,6) minutes, p-value&lt;0.001]; shorter transportation time, [10 (6,17) vs. 11 (6,18) minutes, p-value&lt;0.001]. The median total prehospital time [27 (19,37) vs. 25 (17,34) minutes, p-value&lt;0.001], response time [8 (5,14) vs. 7 (4,11) minutes, p-value&lt;0.001], and transportation time were significantly longer in Group 3 than in Group 2 [11 (6,18) vs. 10 (6,17) minutes, p-value&lt;0.001]. Conclusion: The EMS prehospital time intervals in Thailand during COVID-19 were significantly longer in both the non-trauma and trauma subgroups. Appropriate pre-hospital strategies and monitoring should be developed to manage future pandemics.

Coronavirus disease (COVID-19)-associated mucormycosis (CAM): The unholy triad of COVID-19, diabetes mellitus, and corticosteroid therapy.

The whole world has battled with multiple waves of coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 virus. However, the second wave of COVID-19 had caused a worldwide havoc in terms of disease transmissibility, severity, and mortality. India has been among the worst hit countries during the second wave, which substantially overburdened and overwhelmed the Indian health care system. While secondary infections and co-infections among COVID-19 patients were increasingly being reported, COVID-19-associated mucormycosis (CAM) emerged as a new challenge particularly from India and became a matter of immediate concern. The most common causes attributed to the rise of CAM were undiagnosed/uncontrolled diabetes mellitus, excessive use of corticosteroids, and prolonged hospital stay, all of which create a perfect environment for mucormycosis infection to set in.

The Second COVID-19 Wave Is a Tsunami With Aftershocks: Mucormycosis Ire as Seen in a Tertiary Care Hospital in Uttarakhand, India.

During the spread of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) or the coronavirus disease 2019 (COVID-19) pandemic in recent times, an upsurge of invasive fungal infections (IFIs) such as mucormycosis was witnessed by many countries like India. This COVID-19-associated mucormycosis (CAM) has presented as a menace to the already creaking health infrastructure. Clinical manifestations, risk factors, and end clinical outcomes varied for every other region/country. The aim of this study is to delineate and analyze plausible clinical and epidemiological factors and associated predictors of CAM in suspected patients presenting to a tertiary care hospital in Uttarakhand, India, during the second wave of COVID-19 in India. A total of 200 cases of suspected post‑COVID-19 mucormycosis were enrolled. Data were collected taking into account parameters such as hospitalization and ICU admissions during the episode of COVID-19 infection, steroid/antibiotics/oxygen requirement, and comorbidities such as diabetes mellitus, hypertension, or any chronic illness and outcome. Participants diagnosed with CAM using KOH examination and fungal culture were analyzed in the study (n=46). The median age of patients included was 48, 73.9% were males, and 26% were females. The major predisposing factor was found to be diabetes mellitus type 2. Our work suggests that the mean duration between COVID-19 episodes and CAM was 11.86 days with a significant statistical association. Oxygen requirement and imprudent use of steroids/antibiotics were also allied with mucormycosis. The burden of such IFIs is expected to be unveiled in tropical countries during pandemics such as COVID-19, which lead to immunosuppression in masses post-treatment. Comorbidities such as diabetes, chronic kidney disease, and hypertension add to the risk of acquiring other infectious disease. Such times require competent healthcare professionals such as diagnosticians, physicians, and surgeons who are skilled to manage such IFIs timely.

Sinonasal and Orbital Imaging Findings in COVID-Associated Rhino-Orbito-Cerebral Mucormycosis During the Second Wave of COVID-19: A Retrospective Cohort Study in a Tertiary Hospital in Central India.

Background Mucormycosis is a consequence of the angioinvasive disease caused by filamentous fungi that belong to the order Mucorales, particularly Mucor, Rhizopus, and Rhizomucor. Rhizopus oryzae is the most prevalent form. The invading hyphae lead to damage of blood vessels leading to thrombosis and consequent tissue necrosis. The incidence of this disease entity witnessed a significant rise during the second wave of the coronavirus disease 2019 (COVID-19) pandemic. Timely diagnosis and prompt treatment are crucial to diminish both the mortality and morbidity associated with this disease. Imaging plays a pivotal role in diagnosing the ailment, evaluating its extent, identifying complications such as thrombosis, and facilitating surgical planning. It demonstrates exceptional sensitivity in detecting the disease at its early stages, often before symptoms manifest. Due to the angioinvasive nature of Mucor, early detection assumes utmost importance as it necessitates intensive antifungal therapy and the removal of devitalized tissue through debridement. Methodology We conducted a retrospective cohort study to analyze computed tomography (CT) imaging findings in patients with COVID-associated rhino-orbito-cerebral mucormycosis (ROCM) confirmed by histopathological examination. We compared these findings with CT findings of the nose and paranasal sinuses in patients without mucor following COVID-19 sinusitis (non-ROCM). Results All 16 cases in the non-ROCM group were in stage 1 disease. In contrast, in the ROCM group, three patients had stage 1 disease, five patients had stage 2 disease, and 10 patients had stage 3 disease (p = 0.0001). The pterygopalatine fossa was significantly affected in 10 of 18 ROCM patients and in none of the non-ROCM patients. Conclusions Imaging plays a crucial role in the early detection of mucormycosis. It assists treating physicians in initiating prompt and aggressive treatment, thereby improving the prognosis of this frequently fatal disease.

Effects of the coronavirus disease 2019 pandemic on anxiety and spirituality in patients with cancer undergoing chemotherapy: A cross-sectional study.

e24200 Background: The objective of this study was to evaluate anxiety and spirituality levels in oncology patients during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This short-term cross-sectional study applied a previously validated General Anxiety Disorder-7 (GAD7) scale and spirituality inventory to 230 patients undergoing antineoplastic chemotherapy during the second wave of COVID-19 in Brazil. The means ± SD of the scales were calculated and correlated (Spearman's rho). After categorization, chi-square and multinomial regression models were used to identify risk factors (p &lt; 0.05). Results: The levels of anxiety (6.16±5.11) and spirituality (17.22±2.66) were moderately and inversely correlated (p = 0.001, r = -0.212). Women (p = 0.025), fatigue (p = 0.048), and insomnia (p = 0.001) were associated with an increased incidence of anxiety; however, spirituality was associated with a reduced incidence of fatigue (p = 0.032). Death of family or friends due to COVID-19 increased the risk of high levels of anxiety (p &lt; 0.05), while in multivariate analysis, insomnia (p = 0.030) and sleep difficulty (p = 0.031) were also directly associated with anxiety and spirituality reduced the interruption of chemotherapy during the COVID-19 pandemic (p = 0.036). Conclusions: Fear of the COVID-19 pandemic altered the psychoemotional environment of patients undergoing chemotherapy, resulting in increased levels of anxiety. However, spirituality was an important coping strategy in patients undergoing cancer treatment.

Highlighting the Need for MD-PhD Programs in Developing Countries

In certain developing countries, research output in the medical field has been rising rapidly in the last few decades due to an increased focus on medical research development through different avenues.[1] These indicated an increase in the expenses on research projects, the launch of more research centers, and others.[1] [2] However, this is not the case for most developing countries. Compared with developing countries, developed countries have contributed a lot more to scientific publications in health research.[3] [4] Furthermore, the health research productivity of postgraduate students in low- and middle-income countries was found to be low.[5] In detail, the majority of students infrequently publish their theses. In addition, most published studies are cross-sectional in design, with hardly any clinical trials.[5] The reasons behind that vary, but many of them are common, including limited funding and resources, weak linkage between universities and stakeholders, limited facilities for research training and education, and limited access to health information and literature sources.[3] [6] Such problems have affected medical education in developing countries negatively. For example, in one of the low-income countries, Mozambique, for the period between 2004 and 2010, only 11% of Mozambican University faculty members had a PhD degree, and the shortage of human resources for teaching and mentoring in that country is still an ongoing problem.[7] It has also become clear that developing nations' clinical research needs to be improved if important issues are to be resolved and effective pandemic management tactics are to be selected. As an illustration, the coronavirus disease 2019 (COVID-19) pandemic, which started in the Chinese city of Wuhan in 2019 and is brought on by the severe acute respiratory syndrome coronavirus 2 virus that mostly affects the respiratory tract,[8] has had a major impact on public health in India. Following the second wave of COVID-19 in India, it has been argued that conducting research is essential for low- and middle-income countries so that resources can be allocated properly where they are needed and health systems can develop a greater understanding of what causes good and bad outcomes.[9]

BF.7 Omicron subvariant in India and China: a raising concern - correspondence.

BF.7 Omicron subvariant in India and China: a raising concern - correspondence.

Transmission dynamics and high infectiousness of Coronavirus Disease 2019

&lt;p style='text-indent:20px;'&gt;Coronavirus disease 2019 (COVID-19) has rapidly spread around the world since the early 2020. Recently, a second wave of COVID-19 has resurged in many countries. The transmission dynamics and infectiousness of the COVID-19 pandemic remain unclear, and developing strategies to mitigate the severity of the pandemic is a top priority for global public health. According to the infection mechanism of COVID-19, a novel susceptible-asymptomatic-symptomatic-recovered (SASR) model with control variables in a patchy environment was proposed not only to consider the key characteristics of asymptomatic infection and the effects of seasonal variation but also to incorporate different control measures for multiple transmission routes. The basic reproduction number &lt;inline-formula&gt;&lt;tex-math id="M1"&gt;\begin{document}$ R_{0} $\end{document}&lt;/tex-math&gt;&lt;/inline-formula&gt; was established to describe the spreading behavior in the natural state over a long time horizon, and the natural reproduction number &lt;inline-formula&gt;&lt;tex-math id="M2"&gt;\begin{document}$ R_{n} $\end{document}&lt;/tex-math&gt;&lt;/inline-formula&gt;, which describes the development trend of the disease during a short time in the future, was defined according to the actual propagation characteristics. In addition, the effective reproduction number &lt;inline-formula&gt;&lt;tex-math id="M3"&gt;\begin{document}$ R_{e} $\end{document}&lt;/tex-math&gt;&lt;/inline-formula&gt; considering the control strategies was proposed to evaluate the impact of non-pharmaceutical interventions. The results of numerical simulations for COVID-19 cases in Wuhan, China, based on the SASR model indicate that &lt;inline-formula&gt;&lt;tex-math id="M4"&gt;\begin{document}$ R_{0} $\end{document}&lt;/tex-math&gt;&lt;/inline-formula&gt; was 3.58, &lt;inline-formula&gt;&lt;tex-math id="M5"&gt;\begin{document}$ R_{n} $\end{document}&lt;/tex-math&gt;&lt;/inline-formula&gt; ranged from 2.37 to 4.91, and &lt;inline-formula&gt;&lt;tex-math id="M6"&gt;\begin{document}$ R_{e} $\end{document}&lt;/tex-math&gt;&lt;/inline-formula&gt; decreased gradually from 4.83 on December 8, 2019 to 0.31 on March 8, 2020, reaching 1.40 on January 23, 2020, when the lockdown was lifted in Wuhan. We further concluded that the total number of infections, including asymptomatic infections, was approximately 301, 804 as of March 8, 2020, in Wuhan, China. In particular, this article proposes a dynamic method to distinguish the impact of natural factors and human interventions on the development of the pandemic, and provides a theoretical basis for fighting the global COVID-19 pandemic.&lt;/p&gt;

An Epidemiological Analysis of Severe Acute Repiratory Syndrome Coronavirus 2 Genome Sequencing: A Hospital-based Retrospective Study

Introduction: Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is a positive-sense enveloped single-stranded Ribonucleic Acid (RNA) virus. Structural proteins help the virus package its RNA, while other proteins enable viral replication by facilitating host entry. Through constant mutation, the virus changes its emergence profile, and combinations of mutations can lead to increased transmissibility and receptor binding capacity, altering its surface structure. Whole genome sequencing is an important tool for studying these changes. In this study, the authors report on the genome sequencing of patients who tested positive for SARS-CoV-2 using real-time Reverse TranscriptasePolymerase Chain Reaction (RT-PCR) tests. Aim: To identify the different lineages circulating in specific districts of West Bengal, India, and perform an epidemiological analysis of the patients to control disease severity during the second wave of Coronavirus Disease-2019 (COVID-19). Materials and Methods: This retrospective hospital-based study was conducted at the Virus Research and Diagnostic Laboratory (VRDL) at RG Kar Medical College and Hospital, West Bengal, India from January 2021 to October 2021. Data collection started in January 2021 and was analysed in October 2021. Nasopharyngeal and oropharyngeal swabs were taken from patients with SARS-CoV-2, and the samples were tested using RT-PCR. Positive samples were sent to the Regional Virus Research and Diagnostic Laboratory-National Institute of Cholera and Enteric Diseases (NICED) for sequencing. Samples were collected from patients in different districts of West Bengal who were reported to the VRDL of RG Kar Medical College and Hospital. A total of 172,550 samples were tested for SARSCoV-2, and out of 13,764 positive samples, 230 were sent for genome sequencing. The primary inclusion criteria were SARSCoV-2 positive patients with CT values between 25 and 30 who were vaccinated. Patient information, address, gene variant, and gene mutation of the samples were analysed. Statistical analysis was performed using t-test with Statistical Package for Social Sciences (SPSS) software. Results: Whole-genome sequencing helped identify new trends and their prevalence in specific areas, aiding in prevention efforts. The most common type of mutation observed after double vaccination was the delta variant (B.1.617.2), followed by the kappa variant (B.1.617.1) and the alpha variant (B.1.1.7). Conclusion: Epidemiological genome sequencing studies help to identify emerging and changing viral trends, contributing to the mitigation of the spread of new variants. The delta, kappa, and alpha variants were the three primary sequences discovered in this study. The identification of these lineages facilitates the design of novel vaccines and diagnostic medications. Continuous monitoring and analysis of sequences from new cases in India and other affected countries are crucial for understanding the genetic evolution and substitution rates of SARS-CoV-2.

Prevalence of Adverse Events in Healthcare Professionals Using Personal Protective Equipment to Treat COVID-19: A Web-based Survey

Introduction: Healthcare Professionals (HCPs) involved in managing Coronavirus Disease 2019 (COVID-19) pandemic were instructed to wear Personal Protective Equipment (PPE) to protect themselves from contracting virus. However, PPE use can sometimes lead to adverse events which create greater impact on health status of HCPs. Thus, the prevalence of adverse events and associated risk factors should be estimated for taking necessary preventive measures. Aim: To evaluate the prevalence of adverse events in HCPs due to PPE use during second wave of COVID-19 in Tamil Nadu, India. Materials and Methods: A cross-sectional study was conducted in different levels of healthcare centres in Tamil Nadu, India, from April to May 2021. Data were collected using a pre-validated questionnaire from HCPs of any discipline who were directly involved in managing COVID-19 patients. A total of 282 responses were collected through Google forms and proportion of HCPs who experienced adverse events due to PPE and percentage of different adverse events associated with PPE wearing were assessed. Data were analysed using Chi-square test. Results: Out of 282 respondents of the survey included 224 doctors, 34 nurses and 24 lab technicians with a mean age of 30 years. There were 164 females and 118 males. A total of 177 (62.76%) participants experienced adverse events which included dehydration, thirst and heat, headaches, inability to go to restroom and other urinary/respiratory problems. With respect to duration of exposure to PPE, 163 (57.8%) HCPs had &gt;6 hours/day and 102 (36.2%) had 4-6 hours/day. It was observed that factors such as age, gender, profession, various wards posted for COVID-19 duty and duration of PPE worn daily were significantly associated with adverse events to PPE (p-value&lt;0.05). Conclusion: The results of the study concluded that higher prevalence of adverse events with PPE was seen among doctors and nurses. Most common encountered adverse events were dehydration, headache and skin problems, which have been associated with prolonged use of PPE.

Haematological, Clinical and Radiological Prognostic Markers in Young COVID19 Patients during the Second Wave: A Prospective Cohort Study

Introduction: The devastating outbreak of the second wave of Coronavirus Disease-2019 (COVID-19), resulting in numerous deaths among young individuals, has been the deadliest pandemic witnessed in this century. It caught us off guard by affecting young people and those without any underlying health conditions, leaving profound psychological and economic scars. Aim: To investigate various prognostic markers (haematological and clinicoradiological) in young COVID-19 patients during the second wave. Materials and Methods: This prospective, cohort study was conducted at a tertiary care centre in Karnataka, India from May 1st, 2021, to June 30th, 2021. All COVID-19 patients between the ages of 18 and 45, regardless of their pre-existing health status, who tested positive on Real-time Reverse TranscriptasePolymerase Chain Reaction (RT-PCR)/Rapid Antigen Test (RAT) or showed typical Computed Tomography (CT) changes, were included. Patients with COVID-19 symptoms but negative RT-PCR/RAT results and without typical CT changes were excluded. Clinical, haematological, and radiological parameters were compared between the survivor group and non survivor group, and the results were analysed using measures of central tendency (mean, median, and mode), Chi-square test, and Independent t-test Statistical Package for Social Sciences (SPSS) version 21.0. Results: A total of 624 cases aged between 18 and 45 were included in the study. Among them, 481 (77.08%) patients survived, while 143 (22.92%) patients were dead. Of the 624 cases, 376 (60.26%) were males, 247 (39.58%) were females, and 1 (0.16%) was transgender. Factors associated with increased mortality included older age (&gt;40 years), presentation with cough (119 patients, 83.2%) and dyspnoea (120 patients, 83.9%), asthma (7 patients, 1.1%), clinical classification based on respiratory rate, oxygen saturation, CT changes, and requirement for mechanical ventilation (78 patients, 54.5% in the Severe category and 54 patients, 37.8% in the Critical category), increased white blood cell count (mean μ=9685.8±5470.9), increased neutrophils (μ=8216±4986.9), elevated levels of CRP (μ=96.7±65.84 mg/dL), serum ferritin (μ=571.4±353.15 ng/ mL), LDH (μ=1268.7±835 U/L), D-dimer (μ=74.87±527), serum globulin, ALT (μ=67.6±58.5 U/L), AST (μ=76.4±62 U/L), ALP (μ=120±89 U/L), urea, creatinine, decreased levels of albumin, total protein, haemoglobin, and lymphopenia (μ=1096.1±795.9). Additionally, a CT score &gt;15 was associated with increased mortality. Conclusion: The aforementioned clinical, haematological, and radiological predictive biomarkers were associated with poor outcomes in young COVID-19 patients. Therefore, prompt and intensive management should be implemented to improve the prognosis of these patients.

MALDI-TOF-MS for Rapid Detection of Fungi causing Mucormycosis during COVID-19 Pandemic from a Tertiary Care Hospital in Southern India: A Retrospective Cohort Study

Introduction: Mucormycosis is an opportunistic fungal infection that became a public health emergency during the second wave of Coronavirus Disease-2019 (COVID-19). It is an acute, angioinvasive, opportunistic, and emerging mycosis caused by mucormycetes, resulting in a significantly fatal fungal infection among immunocompromised and/or immunosuppressed individuals. Mucormycosis has a specific predilection for blood vessels (angioinvasive) and tissues, leading to extensive necrosis and thromboembolic events. Globally, the incidence rate of mucormycosis varies from 0.005 to 1.7 per million people. Early diagnosis and appropriate therapy are crucial for clinical outcomes. Aim: To evaluate the mycological profile of mucormycosis during the COVID-19 pandemic using automated Matrix Assisted Laser Desorption Ionisation Time of Flight Mass Spectroscopy (MALDI-ToF-MS) in comparison with conventional fungal identification methods. Materials and Methods: A retrospective cohort study was conducted, collecting data from July 2020 to June 2022, involving 1,176 patients from various clinical departments who attended PSG Hospitals affiliated with PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India. Data analysis was performed from July 2022 to August 2022. Clinical specimens, including Bronchoalveolar Lavage (BAL), Sputum, Cerebrospinal Fluid (CSF), nasal swabs, tracheal aspirates, pus, blood, corneal scraping, eye discharge, and necrotised tissues, were subjected to Potassium Hydroxide (KOH) mount, conventional culture coupled with micrometry-aided microscopy, and MALDI-ToF-MS among suspected mucormycosis cases. The results were collected in Microsoft Excel, and data analysis was conducted using the International Business Machines Statistical Package for the Social Sciences statistical software (IBM SPSS) version 24.0. The study variables were expressed as descriptive statistics: frequency (N) and percentage (%). The incidence of mucormycosis, mycological profile, and diagnostic utility of conventional micrometry-aided microscopy-assisted culture were compared with the automated MALDI-ToF-MS protein signature method of testing. Results: Fungal elements were positive in 130 (11.05%) out of a total of 1,176 clinical samples, such as necrotised tissue, biopsy, and sputum, in the KOH mount. Fungal culture was positive in 258 (21.94%) out of 1176 samples, with mucormycosis detected in 73 (28.29%) of the culture-positive samples. The incidence of mucormycosis in this study was 73 (6.21%) out of 1176. A total of 101 (8.59%) samples showed positive results for mucormycetes through KOH, culture, and MALDI-ToF-MS. MALDI-ToF-MS could rapidly and specifically identify and confirm the causative agents of mucormycosis at their genus and species levels compared to KOH or culture. Conclusion: Simple, low-cost, and less laborious conventional culture coupled with micrometry-aided microscopy can detect Mucorales at the species level, where KOH microscopy could not differentiate between species. MALDI-ToF-MS can be employed for the rapid detection and confirmation of mucormycosis agents at the genus or species level

Full Mouth Rehabilitation of a Post COVID-19 Mucormycosis Treated Patient using BarRetained Prosthesis: A Case Report

During the second wave of Coronavirus Disease-2019 (COVID-19), the Indian subcontinent had witnessed a steep rise in the postCOVID mucormycosis cases with an alarming rate of about 70 times than that of the rest of the world. Maxillofacial defects amounted to various post-surgical hindrances such as difficulty in mastication, impaired speech, nasal regurgitation, mental despair and socially awkward situations. Dentists all over the world were challenged for fabricating a well-retained and functionally comfortable prosthesis that would contribute in improving the condition of a physiologically-debilitating and psychologically-impaired patient. Here the authors present a case of 65 years old male patient, full mouth rehabilitation of post-COVID mucormycosis treated patient wherein a bar-retained prosthesis was delivered which was not only non-invasive but highly retentive and even pocket-friendly for the patient. This case report also shows that through meticulous planning and execution of the treatment plan, one can achieve the desired results and meet the patient’s expectations.

Magnitude and associated factors of menstrual irregularity among young girls: A cross-sectional study during COVID-19 second wave in India.

Several symptoms are typically experienced after a coronavirus disease 2019 (COVID-19) infection. Worldwide, a lot of women are reporting irregularities in their menstrual cycles post-COVID-19 infection. The purpose of this study is to investigate the prevalence of menstrual pattern among young girls during the second wave of COVID-19 pandemic and to determine the risk factors related to lifestyle among young girls. A cross-sectional study was conducted using a self-designed questionnaire encompassing details of the menstrual pattern, features of hyperandrogenism, lifestyle, and comorbidity among young girls aged 16-24 years. The data from 508 girls fulfilling the inclusion criteria were analyzed. The prevalence of irregular menstrual cycle was found to be 29.1%. Further analysis revealed that a significant percentage of girls with irregular menstrual cycle suffer from depression (14.9%) and are often staying stressed (40.5%) in comparison to the girls having regular menstrual cycle. Also, a total of 58 girls out of 508 were diagnosed with polycystic ovary syndrome (PCOS). Among various comorbid conditions, obesity was found in 60% of girls having PCOS followed by an eating disorder. A significant increase in irregular menstrual cycle in young girls was found during the second wave of COVID-19. The risk factors for causing the irregular menstrual cycle were found to be insomnia, stress, and depression.

Emerging Syndemic: Black Fungus–A Post-COVID-19 Mucormycosis

Novel coronavirus has created a havoc in India; about 30 million cases have been reported and 0.4 million deaths are recorded till now due to coronavirus disease 2019 (COVID-19). But nowadays, some patients of COVID-19 in India are battling a very rare but fatal disease, that is, mucormycosis or “black fungus” disease. The consciousness about the black fungus disease in many people of India is due to its rising cases of COVID-19-associated mucormycosis (CAM) mostly among the people who have recovered from COVID-19. Following recovery from COVID-19, thousands of cases of several complications of patients regarding CAM are reported especially during the second wave of COVID-19 in India. Mucormycosis or “black fungus” is a rare disease caused by fungi belonging to the order Mucorales. It is a disease observed following infection with the novel coronavirus in India and has already taken the form of a pandemic in many states.[1] [2] Therefore, scientists have chosen to name the disease as a syndemic since this is synergistically created with the pandemic. The ubiquitous molds of mucormycosis having a worldwide dispersal, including the Rhizopus, Apophysomyces, Mucor, and Lichtheimia species, are found in plants, soil, decaying fruits and vegetables, and even in air. If contact occurs with airborne spore, then it germinates into hyphae and is regarded a very rare occurrence. This preferentially takes place inside the bucconasal cavity. After germination, it can invade the neighboring tissue and blood vessels that results in characteristic hemorrhage followed by black color development. The visualization of these dark necrotic tissues on skin and blood vessels of the affected person is termed as black fungus disease. Till now five major forms of mucormycosis have been identified, for example, rhinocerebral (44–49%), cutaneous (10–16%), pulmonary (10–11%), disseminated (6–11.6%), and gastrointestinal (2–11%) forms. Among these, the most common rhinocerebral form usually occurs in immunocompromised individuals. It exhibited a “pattern paranasal infection” with a porch into the oral cavity often. It is a quickly emerging angioinvasive infection, with rhinoorbital-cerebral and pulmonary manifestations. According to the Indian government, there are over 11,700 reported cases and over 126 casualties as of May 2021.[3] There is a surge in terms of infection rates. Though mucormycosis is generally regarded as harmless to an immunocompetent host, it may be fatal in some cases in its combination form with factors like indiscriminate use of steroids or other immunosuppressants, even in subjects presenting with mild symptoms of COVID-19. Immunocompromised patients like people with hematological malignancies, damaged mucosal layer, uncontrolled diabetes, ketoacidosis, and viral induced lymphopenia are the prime victims of this deadly fungus.[4] It is a fatal disease if unnoticed as it is invasive to blood vessels, distant organs, nose, mouth, eyes, sinus, and even brain. If untreated, the infection usually develops speedily, and leads to death within a few days of contamination.